Miscellaneous

• Neonatal Hypoglycaemia → common in first few hours after birth. Risk factors for persistent hypoglycaemia include preterm birth, maternal diabetes, IUGR, hypothermia. If asymptomatic, encourage normal feeding and monitor blood glucose. If symptomatic or very low blood glucose (<1), admit to NICU and IV 10% dextrose.
• Choking → encourage patient to cough > backslaps > heimlich manouevere.
• Edward’s Syndrome → trisomy 18. Features include oesophageal atresia, omphalocele (intestines protruding outside the body), microcephaly (small head), low set ears, and overlapping digits.
• Speech Development → red flag if no words by 18 months. First abnormality to exclude is hearing related (do otoacoustic emission testing in 18 month old).
• Paediatric BLS → 5 rescue breaths > check for signs of circulation (infants = brachial or femoral, children = femoral) > 15 compressions: 2 rescue breaths.
  • Compressions over lower half of sternum. Rate of 100-120/min.
• APGAR Score → used to assess health of newborn baby. Should be assessed at 1 and 5 minutes of age (if low then repeat at 10 mins). Takes into account appearance (colour), pulse (heart rate), grimace (reflex irritability), activity (muscle tone), respiratory effort.
• Foetal Alcohol Syndrome → common cause of microcephaly (abnormal small head). Baby may show symptoms of alcohol withdrawal at birth (irritable, hypotonic, tremors).
• Red (High-Risk) Features for Febrile Child <5 years → RR >60, reduced skin turgor, age <3 months + temp ≥38. Need urgent referral to paediatric specialist.
• Hearing Testing → newborn = otoacoustic emission test, >3 years old = pure tone audiometry.
• Microcephaly (small head circumfrance) → normal variation, familial, congenital infection, hypoxic ischaemic encephalopathy, fetal alcohol syndrome, patau syndrome, craniosynostosis.
• Child Abuse → story inconsistent with injuries, repeated attendances at A&E departments, delayed presentation, child with a frightened/withdrawn appearance.
• Anaphylaxis → administer 300mcg IM adrenaline 1:1000.
• Infantile Colic → benign set of symptoms. Typically occurs in those <3 months old, characterised by excessive crying and pulling-up of the legs, often worse in the evenings.

Cardio

• Patent Ductus Arteriosus → non-cyanotic congenital heart disease, connection between pulmonary trunk and descending aorta. Indomethacin or ibruprofen (prostaglandin E2 inhibitors) is given to the neonate in the postnatal period.
• Ventricular Septal Defect → associated with congenital abnormalities (eg. down’s syndrome). Causes pansystolic murmur.
• Tetralogy of Fallot (CYANOTIC) → VSD, overriding aorta, pulmonary stenosis (determines degree of cyanosis), RVH.
• Coarctation of the Aorta → causes weak femoral pulses. Discuss immediately with paediatrics.